Toby Capstick

Bio: Toby Capstick is an academic researcher from Leeds Teaching Hospitals NHS Trust. The author has contributed to research in topics: Inhaler & Asthma. The author has an hindex of 5, co-authored 8 publications receiving 280 citations.

British Thoracic Society Guideline for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD)

Abstract: The full guideline for the management of non-tuberculous mycobacterial pulmonary disease is published in Thorax. The following is a summary of the recommendations and good practice points. The sections referred to in the summary refer to the full guideline.

Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: a systematic review and meta-analysis.

Abstract: The acute respiratory distress syndrome (ARDS) secondary to viral pneumonitis is one of the main causes of high mortality in patients with COVID-19 (novel coronavirus disease 2019). We systematical...

Are severe asthma patients at higher risk of developing severe outcomes from COVID-19?

Abstract: One of the key concerns in asthma management during the novel coronavirus disease 2019 (COVID-19) pandemic is the fear for an increased risk of contracting the novel coronavirus or developing a severe course of COVID-19 in asthmatic patients, especially those receiving inhaled corticosteroids (ICS) or biological therapies.1,2 Therefore, the study by Heffler et al3 to determine the incidence of COVID-19 among patients with severe asthma in Italy is highly appreciated to reveal the association between the presence of severe asthma and the acquisition of COVID-19, as well as its complications. However, the observations by the authors that severe asthmatic patients may not be at increased risk of acquisition of COVID-19 and development of a severe course of illness may not hold true. Although only 1.73% of severe asthmatic patients included in the study by Heffler et al3 had confirmed COVID-19 or were highly suspected to have had COVID-19, we think that there are many possible explanations to the observed low incidence. Patients from different countries may have a different background risk of acquisition of COVID-19, related to organizational factors including the enforcement of lockdown measures, compliance towards social distancing recommendations or testing frequency for COVID-19, and patient factors such as the presence of comorbidities other than asthma, amongst others. Therefore, observational studies among a large cohort of COVID-19 patients are required to determine whether patients with severe asthma are over-represented. Similarly, due to a low incidence of COVID-19 in the included severe asthmatic patients, the comparison of the COVID-19–associated mortality rate between the included severe asthmatic patients and the Italian general population may not be accurate to suggest that severe asthmatic patients with COVID-19 are not at an increased risk for development of a severe course of illness. Other studies have suggested the association between severe asthma phenotypes and poor clinical outcomes from COVID-19. In a retrospective study by Chhiba et al4 to determine the risk of hospitalization for COVID-19 associated with ICS use among asthmatic patients, a trend was noticed in which the proportion of asthmatic patients using ICS + long-acting beta-agonist (LABA) and admitted to intensive care unit was far higher (57.9%) compared with those using only ICS (10.5%). Such findings suggested the possibility that those with more severe asthma who require both preventer (ICS) and controller (LABA) may be at risk of developing a severe course of illness from COVID-19. A recent study available as a preprint suggested the same. Researchers from the OpenSAFELY Collaborative5 evaluated the association between ICS use and COVID-19–related death among asthmatic patients using linked electronic health records in the United Kingdom. In an adjusted model among the asthmatic population, COVID-19 patients who received ICS at high dose had a significantly increased risk of COVID-19–related death compared with those who received short-acting beta-agonist (SABA) alone (hazard ratio = 1.52; 95% confidence interval: 1.08-2.14), whereas COVID-19 patients who received ICS at low/moderate dose had no significant difference in terms of the risk of COVID-19–related death compared with their counterparts who received SABA alone (hazard ratio = 1.10; 95% confidence interval: 0.82-1.49). These findings hinted at a possibility that those with more severe asthma who require a higher dose of ICS to maintain asthma control may be at risk of a worse prognosis from COVID-19. Though some may argue that those receiving high-dose ICS use may have more overwhelmed immunosuppression, it has been somewhat refuted in the study by Chhiba et al4 which reported that the patients with the combined use of ICS and LABA which possesses corticosteroid-sparing effect too had an increased risk of admission to the intensive care unit. We opined that more comprehensiveness evaluation may be needed to determine the association between the presence of severe asthma and the acquisition of COVID-19, as well as the risk for severe illness from COVID-19.

Consistency of recommendations from clinical practice guidelines for the management of critically ill COVID-19 patients.

Abstract: Background A significant knowledge gap exists for the management of critically ill patients with coronavirus disease 2019 (COVID-19). This study aimed to systematically investigate the consistency of recommendations from the available clinical practice guidelines (CPGs) to those of the WHO on the management of critically ill COVID-19 patients. Methods We examined CPGs and UpToDate point-of-care resources on the management of critically ill COVID-19 patients that had been published as of 30 April 2020 and compared them against the CPG by the WHO. The main outcome was the rate of consistency among CPGs for the management of critically ill COVID-19 patients. Sensitivity analyses were conducted by excluding recommendation statements that were described as insufficient evidence and by excluding single CPGs one at a time. Results Thirteen reference recommendations derived from the CPG of the WHO were generated using discrete and unambiguous specifications of the population, intervention, and comparison states. Across CPGs, the rate of consistency in direction with the WHO is 7.7%. When insufficient evidence codings were excluded, the rate of consistency increased substantially to 61.5%. The results of a leave-one-out sensitivity analysis suggested that the UpToDate recommendation source could explain the inconsistency. Consistency in direction rates changed by an absolute 23.1% (from 1/13 (7.7%) to 4/13 (30.8%)) if UpToDate was removed. Conclusions We observed inconsistencies between some recommendations of the CPGs and those of the WHO. These inconsistencies should best be addressed by consensus among the relevant bodies to avoid confusion in clinical practice while awaiting clinical trials to inform us of the best practice.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Abstract: Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

A National Survey

Abstract: So far I have attempted to provide a broad framework within which to consider the importance of managerial and organisational integration. Inevitably in so doing I have found it necessary to raise wider educational and training issues which influence not only conceptual skills but also attitude. Indeed I have, on occasion, moved my argument or perspective to even wider considerations; issues pertaining to national culture. Culture, education policy or structure, industrial organisation, all interact in subtle and perhaps devious forms. Thus a cultural framework which is “overly status or class conscious” reflects this in its educational system. Most likely it is more predisposed to segment its secondary and tertiary education systems according to similar principles. It may well encourage separation of the university and technical college or polytechnic system to a degree that is industrially and commercially counterproductive — and integratively devisive. Such an educational system will no doubt require “preselection and filtering” which relies upon early, too early, subject specialisation; it may, subsequently, influence adversely the need for individuals and subgroups to communicate more intimately and to organise themselves more closely. In fact it may ensure the continuance of barriers, hierarchies, and polarised attitudes of class, structure and function all the way across and through commerce and industry.

Risk factors for severe and critically ill COVID-19 patients: A review.

Abstract: The pandemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused an unprecedented global social and economic impact, and high numbers of deaths. Many risk factors have been identified in the progression of COVID-19 into a severe and critical stage, including old age, male gender, underlying comorbidities such as hypertension, diabetes, obesity, chronic lung diseases, heart, liver and kidney diseases, tumors, clinically apparent immunodeficiencies, local immunodeficiencies, such as early type I interferon secretion capacity, and pregnancy. Possible complications include acute kidney injury, coagulation disorders, thoromboembolism. The development of lymphopenia and eosinopenia are laboratory indicators of COVID-19. Laboratory parameters to monitor disease progression include lactate dehydrogenase, procalcitonin, high-sensitivity C-reactive protein, proinflammatory cytokines such as interleukin (IL)-6, IL-1β, Krebs von den Lungen-6 (KL-6), and ferritin. The development of a cytokine storm and extensive chest computed tomography imaging patterns are indicators of a severe disease. In addition, socioeconomic status, diet, lifestyle, geographical differences, ethnicity, exposed viral load, day of initiation of treatment, and quality of health care have been reported to influence individual outcomes. In this review, we highlight the scientific evidence on the risk factors of severity of COVID-19.